AbstractBackgroundAccording to a 2017 Centers for Disease Control and Prevention (CDC) report, there were 23.1 million Americans living with diagnosed diabetes. Diabetes-related complications in pregnancy are spontaneous abortion, preterm delivery, preeclampsia, fetal malformations, altered fetal growth, polyhydramnios, and unexplained fetal demise. Continuous insulin delivery through insulin pump is used for effective management of type 1 diabetes (T1DM).Case presentationWe present case reports of four patients who were on insulin pump for at least 1 year prior to pregnancy and continued throughout their pregnancy. Although these case reports demonstrated overall good pregnancy outcomes, it did not show how well their blood glucose was controlled during pregnancy.ConclusionStandard of care in diabetic management during pregnancy using insulin pump in the presented case reports supports the American Association of Clinical Endocrinologists recommendation that insulin pump should be used for women with preexisting T1DM during pregnancy.

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Objective: Erythropoiesis stimulating agents (ESAs) are required in most of the patients with end-stage renal disease (ESRD) for treatment of anemia. Subnormal testosterone concentrations are very common in men with ESRD. Since testosterone is erythropoietic, testosterone replacement therapy (TRT) has the potential to increase hemoglobin and decrease ESA usage in hypogonadal men with ESRD. Methods: We reviewed charts of men on hemodialysis with subnormal testosterone concentrations at a dialysis center. The hemoglobin concentrations and ESA doses (adjusted for hemoglobin and body weight) of those who were treated with TRT (n = 10) were compared with those who did not receive TRT (n = 10). Results: The average duration of TRT was 18-2 weeks. Hemoglobin concentrations increased by 1.2-1.3 g/dL in the treated group but did not change in the untreated group (p = 0.02 for comparison between groups). ESA doses decreased by 20% in the TRT group but did not change in the untreated group (p = 0.03 for comparison between groups). Four out of the 10 men in the TRT group were no longer on ESAs by the end of the study, whereas all men in the untreated group continued to require ESAs throughout the study. Conclusion: TRT increases hemoglobin concentrations and reduces the requirement of ESAs in men with subnormal testosterone concentrations on hemodialysis.